A majority of high-volume first trimester providers (abortion clinics) offer intravenous moderate sedation. However, many individual practitioners are limited in their ability to provide outpatient moderate sedation, and research has shown mixed results about its efficacy. There continues to be a dilemma in terms of what constitutes optimal anesthesia for first trimester abortions to maximize pain control and minimize side effects and duration of hospital/clinic stay for the patients. A randomized, double blind, placebo controlled trial of intravenous fentanyl (50-100 mcg) with local anesthesia versus placebo and local anesthesia alone in 368 participants found that fentanyl, when compared with placebo, reduced the pain of first trimester abortion by 1.0 point on an 11-point verbal numerical scale. The investigators concluded that this pain reduction was of questionable clinical significance and less than what study participants desired (2.0 points). Another randomized, double blind, placebo controlled study in 100 participants compared local anesthesia alone to local anesthesia with intravenous fentanyl (25mcg) and midazolam (2mg) for first trimester suction curettage. There was no statistically significant difference in pain scores between the groups. However, patients who received intravenous sedation reported increased satisfaction with their abortion procedure.11